Benefix General Presentation

The Problem
• Out of control employee benefit costs
– 60% Increase in Health Insurance Premiums in last 10 years*
– Deductibles for employee-sponsored health plans have increased by
67% since 2010*
– 63% of Americans don’t have $500 in savings to cover out-of-pocket
medical costs in the event of an injury or sickness**
• Predatory providers in the ancillary benefit space
(e.g., dental and vision)
• Small businesses lack access to benefits available to
large employers
• Dynamic regulatory environment for U.S. businesses
• Challenge recruiting and retaining quality employees
*Kaiser Family Foundation/Health Research & Education Trust 2016 Employer Health Benefits Survey.
** BankRate, 2016.

The Problem
• Commercial insurance companies
 Excessive pricing (18-
30% on average)
 Limited access to
specialty care
 Subjects participants to
pricing volatility
 Hold excessive reserve
and profit margins

The Problem

The Solution
BIG BENEFITS
FOR
SMALL EMPLOYERS

BENEFIX
• Big Benefits for Small Employers
– Health and dental care without the middleman
– Two-tiered health care strategy – Captive + Gap
Coverage – to radically reduce employer cost and
minimize employee out-of-pocket expenses
– Access to big employer benefits, including:
 Ancillary and supplemental benefits and pricing
 Financial management resources
 High-level human resources support

Captive Case Study
• The UC Regents Captive Insurance Company:
– $1.2 billion in assets
– $980 million annual insurance premiums*
• $25–30 million in savings generated**
*Insures +/- $50 billion of property, five medical centers, 7,000+ physicians, employees,
campuses, sports teams, and 80,000 registered student associations
**Plan year 2017

BENEFIX
• Captive replaces the commercial insurance
company (e.g., Blue Cross) and provides the
legal entity – a licensed insurance company – to
provide benefits to employees
• The captive provides:
– Actuarial, underwriting, claims
management, stop loss, etc.
– Full transparency
– 360° health care data – far beyond what
traditional health insurance companies are able
to provide

BENEFIX
• Level Funded Insurance
– Alternative to traditional health
plans offered under the ACA
– Saves small businesses up to
30% while providing basic
coverage for employees
– Includes stop loss protection
against catastrophic or
unpredictable losses

BENEFIX
• GAP+
– Gap insurance covers deductibles and co-
insurance expenses for employees
– The unique structure of GAP+ provides this
coverage at no cost to employees willing to
engage in monthly wellness programs
(Employees who participate in an HMO or HSA are eligible for HIP+
coverage)
Coverage through
level-funded health
insurance (captive)
GAP+
coverage

Without
GAP+
With
GAP+
Semi Monthly Pay $1,500 $1,500
GAP+ Premium $0 $239
Payroll Taxes $375 $315
Net Pay $1,125 $946
Eligible Claim Payments $0 $199*
Net Take Home $1,125 $1,145
Paycheck illustration for a 38-Year-Old Employee with an annual salary
of $36,000 GAP+ policy with $4,000 in-patient and $2,000 out-patient
benefit.
*Claim payments require monthly participation in the Health Risk Management Program
GAP
+
BENEFIX

BENEFIX
• Step 1: Implement level-funded base health
plan with GAP+ through captive
– Timeline: Applications can be taken immediately;
implementation in 60 days
– Estimated savings over existing health plans: 18-
30% ($1,500-3,500/employee/year)
Outcome: 3 year aggregation of live monthly claims
+ health data for all participants

BENEFIX
• Step 2: With 3 years of 360° data (claims
and health data) to determine best next
step…
– Remain in captive with level funding; or
– Transition to a fully self-funded program
• Direct contracting with providers
• Significant cost savings
– 30-40% savings from traditional health insurance
– Average annual reduction in claims utilization of 10%
• All reduction in claims become income to
participating employers on a pro-rated basis

BENEFIX
• Supplemental voluntary benefits
– Best-in-class benefits, for example:
• Guaranteed issue life insurance with long term care rider
• Accident indemnity
• Critical Illness indemnity
– Level commission structure = 20-30% lower costs
– Will educate community brokers on available products

BENEFIX
• Financial management resources
– Concierge support to navigate benefits
EOB disputes
Financial planning for specialty care
– Flexible spending accounts
Health Care
Dependent Care
– Student loan repayment
– Retirement Planning (e.g., 401(k))

BENEFIX
• Comprehensive HR & Compliance Support
– Access thousands of easily searchable resources in one central
online location
 Employee communications
 HR forms and employee handbook
 Educational articles
– Valuable compliance resources
 ACA
 FMLA
 COBRA
 HIPAA
 Notices and disclosures
– Receive the latest content, including breaking legislative news
 HR Hotline
 Legal Resources

BENEFIX
• Getting Started
– Letter of intent
– Form captive cell, establish networks, and
negotiate pricing
– Gather census and plan data from
businesses

BENEFIX
Contact Information
ActNow Strategies, LLC
936 S. Olive St., Suite 408
Los Angeles, CA 90015
(213) 387-0780
www.ActNowStrategies.com

Benefix General Presentation

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